Cerebral microemboli and brain injury during carotid artery endarterectomy and stenting.
OBJECTIVE
Cerebral microembolic signals detected by transcranial Doppler are frequent during carotid angioplasty with stenting and carotid endarterectomy (CEA). Their potential harmful effects on the brain are, however, unclear. The aim of this study was to relate the frequency and type of per-procedural microembolic signals to procedure-related ipsilateral ischemic strokes and new ipsilateral ischemic lesions on diffusion-weighted cerebral MRI.


METHODS
Eighty-five patients who were prospectively treated with CEA (61) or carotid angioplasty with stenting (30) for high-grade (>/=70%) internal carotid artery stenoses were monitored during the procedures using multifrequency transcranial Doppler with embolus detection and differentiation. Pre- and postprocedural cerebral diffusion-weighted cerebral MRIs were performed on a subset of patients.


RESULTS
Solid and gaseous microemboli were independently associated with procedure-related ipsilateral ischemic strokes (solid: P=0.027, gaseous: P=0.037) or new ipsilateral diffusion-weighted cerebral MRI lesions (solid: P=0.043, gaseous: P=0.026). Microembolic signals were detected during all procedures except one (CEA); 17% and 21% of all emboli were solid during carotid angioplasty with stenting and CEA, respectively. Patients undergoing carotid angioplasty with stenting had more solid (P<0.001) and gaseous (P<0.001) emboli and more new ipsilateral ischemic strokes (P=0.033) compared with patients undergoing CEA. Echolucent plaques (P=0.020) and preprocedural diffusion-weighted cerebral MRI ischemic lesions (P=0.002) were associated with increased numbers of solid emboli.


CONCLUSIONS
Solid and gaseous microemboli were increased in patients with procedure-related ipsilateral ischemic strokes or new diffusion-weighted cerebral MRI lesions, which suggests that both solid and gaseous emboli may be harmful to the brain during CEA and carotid angioplasty with stenting.
Skjelland
Mona
M
Department of Neurology, Rikshospitalet Universty Hospital, 0027 Oslo, Norway. mona.skjelland@rikshospitalet.no
Krohg-Sørensen
Kirsten
K
Tennøe
Bjørn
B
Bakke
Søren J
SJ
Brucher
Rainer
R
Russell
David
D
D000368:Aged; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002545:Brain Ischemia / Q000401:mortality* / Q000473:pathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D015897:Comorbidity; D038524:Diffusion Magnetic Resonance Imaging; D004618:Embolism, Air / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000473:pathology; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial